Cervical Cancer Awareness Month: Why an increasing number of younger women are at risk of this disease

Gynaecologists at different hospitals report having observed women as young as 25 years of age being detected with cervical cancer compared to 35-40 years earlier. “This ten-year shift has occurred as a result of women becoming sexually active at an early age and without adequate education about contraception. Despite a vaccine being available against HPV and increased accessibility and availability of contraceptives, there is a lack of awareness. That is why young women are presenting with cervical changes and being HPV positive, not just for cervical cancer but also for oral or anal cancers,” Dr Sujit Ash, consultant, gynaecology and obstetrics, PD Hinduja Hospital and Medical Research Centre, Khar told indianexpress.com.

As such, this Cervical Cancer Awareness Month, observed in January, is an ideal time to talk about why more young women are being diagnosed with cervical cancer, and what can be done to prevent it.

Let’s dive into the basics.

What is this cancer all about?

Cervical cancer occurs when healthy cells on the cervix become infected with HPV and multiply rapidly forming a mass or tumour, which can be cancerous or benign. “Initially, these changes are not cancerous but they can gradually lead to cancer. Precancerous tissue needs to be removed to stop cancer from developing. If the precancerous cells change into cancer cells and spread deeper into the cervix or to other tissues and organs, the disease is then called cervical cancer or invasive cervical cancer,” said Dr Paula Goel, consultant paediatrician, adolescent physician, founder of Fayth Clinic.

There are two main types of cervical cancer named for the type of cell where cancer starts:

– Squamous cell carcinoma makes up about 80 to 90 per cent of all cervical cancers.
– Adenocarcinoma makes up 10 to 20 per cent of all cervical cancers.

Where is the cervix located?

The cervix is the lower narrow end of the uterus at its junction with the vagina. When cells lining this part of the uterus undergo neoplastic-cancerous change, we call it cervical cancer. “The location of cervical cancer is usually where the endo cervix meets the ecto cervix – what is commonly referred to as ‘transformational zone’,” said Dr Niti Raizada, senior director, medical oncology, hemato-oncology, Fortis Group of Hospitals, Richmond Road Bengaluru.

How and why does this part of the uterus get cancer?

The most common cause, according to Dr Raizada, is a long-lasting infection caused by HPV. This virus is sexually transmitted, and it is estimated that “at least half of the sexually promiscuous people get infected with HPV at some point in their lives. Thankfully, even though HPV infection is so prevalent, only a small fraction of them actually suffer from cervical cancer”.

Who is more prone to cervical cancer?

Individuals who are infected with HPV are prone to cervical cancer, said Dr Goel. Since males do not have a cervix, they cannot get cervical cancer; however, sexually active men can be infected with HPV, said Sujit noted. “Due to HPV infection, men may develop HPV-associated cancer of the mouth and throat, penis, or anus from particular strains of the virus. And currently, there are no tests available to check for this virus in men,” Dr Sujit told indianexpress.com.

“More than 40 HPV types can infect the genital areas of men and women,” Dr Goel said.

The International Agency for Research on Cancer found that 13 HPV types can cause cervical cancer. “At least four out of every five women, by the age of 50 years, would have been infected with HPV. HPV is also very common in men but has no symptoms. In India, about five per cent of women in the general population are estimated to harbour cervical HPV-16/18 infection at a given time, and 83.2 per cent of invasive cervical cancers are attributed to HPVs 16 or 18,” Dr Goel noted.

Cervical cancer, a malignant tumour of the cervix, is the second most common cancer among women in India (Source: Getty Images/Thinkstock)

Symptoms

Experts suggest that early-stage cervical cancer “generally has no signs or symptoms”. Advanced cervical cancer includes:

*Vaginal bleeding after intercourse, between periods or after menopause
*Watery, bloody vaginal discharge that may be heavy and have a foul odour
*Pain during intercourse
*Unexplained, persistent pelvic and/or back pain

How is it diagnosed?

Many tests used for diagnosing cervical cancer, depending on:

– The type of cancer suspected
– Signs and symptoms
– Age and general health
– The results of earlier medical tests

The following tests are used to diagnose:

*Bimanual pelvic examination
*Pap test
*HPV typing test.
*Colposcopy- to help guide biopsy of the cervix
*Biopsy.
*MRI – used to measure the tumour’s size.
*PET scan
*Biomarker testing of the tumour.

When to get screened?

Dr Goel listed down the measures:

*Between 21 to 29 years of age – If your pap test comes normal- wait three years for next pap test.
*Between 30 to 65 years of age –If only an HPV test is done and is normal – wait for five years till the next screening. If an HPV test along with a pap smear is done (co-testing) and both results are normal – wait five years till the next screening. If only a pap smear is done and is normal – wait three years until the next pap test.
*(Screening not required – if hysterectomy (surgical remove of uterus) is done

How is a smear test conducted?

A smear is taken from the junction of the cervix and vagina and tested under the microscope by a pathologist using special stains to detect cancer. “It is usually recommended between ages of 20-65 years in periodic intervals of 3-5 years with or without HPV testing,” Dr Raizada said.

Treatment

Treatment of the precancerous area depends on:

*The size of the lesion and the type of changes that have occurred in the cells
*The patient’s desire to have children
*The patient’s age and general health
*Treatment is conducted by a team of doctors called a multidisciplinary team including physicians, oncologists, surgeons, oncology nurses, social workers, pharmacists, counsellors, and dietitians.

Identifying the right treatment for the patient is important, especially in the advanced stages, stressed Dr Amit Verma, molecular oncologist and cancer geneticist. “This is called precision oncology. Therefore, it is important to discuss all the options with the gynaecologist, oncologists including surgical, medical, radiation and molecular oncologist,” he said.

To prevent cancer from spreading, different procedures are used. Surgery is the removal of the tumour and some surrounding healthy tissue during an operation, said Dr Goel.

– Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells.
– For early stages of cervical cancer, a combination of radiation therapy and low-dose weekly chemotherapy is often used.
– Medications are given to destroy cancer cells orally or intravenously, called chemotherapy. Targeted therapy is a treatment that targets cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival.
– Immunotherapy- It uses the body’s natural defences to fight cancer by improving your immune system’s ability to attack cancer cells
– Cancer and its treatment have emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. People who receive palliative care along with treatment for cancer often have less severe symptoms and better quality of life, and report that they are more satisfied with treatment.
– Hospice care is designed to provide the best possible quality of life for people who are near the end of life.

When cervical cancer is found early, it is highly treatable and associated with a good quality of life (Source: Getty Images/Thinkstock)

Prevention

If cervical cancer is found early, it is highly treatable and associated with a good quality of life, experts suggest.

Dr Goel stressed that it can be prevented by having regular screenings with pap tests and human papillomavirus (HPV) tests to find any precancers and treat them. It can also be prevented by receiving the HPV vaccine.

It is to be noted that both males and females should ideally be vaccinated. “Sexually active men may not even realise that they have been infected with the HPV virus and it usually just goes away. But it can lead to future penile cancers, and there could be tell-tale evidence of warts (small growths) which are missed by them till it is too late,” Dr Raizada noted.

Other preventive measures include:

*Delaying first sexual intercourse
*Limiting the number of sexual partners
*Practicing safer sex by using condoms
*Avoiding sexual intercourse with people who are infected with genital warts or who show other symptoms
*Quitting smoking

Vaccination of women as early as their teenage will prevent this cancer. Dr Sujit added that men should also get the HPV vaccine alongside women and practice safe sex.

But a nationwide vaccination program is “quite a cost and logistical nightmare for the government to bear it with so many innumerable other healthcare priorities jostling for attention”, said Dr Raizada.

“This is where public awareness and PPP –i.e., Public Private Partnership will help in combating this disease,” Dr Raizada mentioned.

“In July of 2022, the DCGI (Drug Controller General of India) granted marketing authorisation to a vaccine developed by Serum Institute of India in collaboration with Government of India, to enable low cost vaccine for all females and males aged between 9-26 years. Ideally if every individual in that age group gets vaccinated then the future incidence of cervical cancer will drop significantly,” added Dr Raizada.

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